PURPOSE: The purposes of this study are to evaluate clinical characteristics of malnourished patients who received nutritional therapy and to compare their clinical courses according to nutritional support team (NST) consultation in tertiary referral hospital in Korea. METHODS: From June 2014 to May 2015, 43,954 admitted patients who were more than 18 years old were retrospectively investigated. Characteristics of patients who received enteral nutrition (EN) or parenteral nutrition (PN) for more than 3 days (nutritional therapy group) were compared to the patients without nutritional therapy (control group). In addition, clinical courses according to NST consultation (NST group and non-NST group) were compared through propensity score matching (PSM). RESULTS: EN or PN was applied in 4,599 patients for more than 3 days (nutritional therapy group: 10.5%). For characteristics, there were significant differences between two groups (nutritional therapy group vs. control group) with age, male proportion, body weight, body mass index. All laboratory data at admission were significantly worse in nutritional therapy group. And for clinical courses, there were significant differences in length of stay (LOS), rate of intensive care unit (ICU) admission, LOS in ICU, Acute Physiology and Chronic Health Enquiry (APACHE II) score, days of nutritional therapy, mortality rate. NST consultation was made in 39% of nutritional therapy group. Among departments, Thoracic Surgery showed the highest rate of NST consultation (68.5%) otherwise Neurosurgery showed the lowest rate (18.7%). When PSM between NST group vs. non-NST group were made, significant differences was shown only in the rate of ICU admission, EN or PN support days, cholesterol at discharge. CONCLUSION: In tertiary referral hospital in Korea, more than 10% of patients still needed active nutritional therapy. NST consultation rate varies among departments. We failed to find significant differences between NST group and non-NST group.
Body Mass Index ; Body Weight ; Cholesterol ; Enteral Nutrition ; Humans ; Intensive Care Units ; Korea* ; Length of Stay ; Male ; Mortality ; Neurosurgery ; Nutrition Therapy ; Nutritional Support ; Parenteral Nutrition* ; Physiology ; Propensity Score ; Retrospective Studies ; Tertiary Care Centers* ; Thoracic Surgery ; Treatment Outcome

We report a case of celiac artery dissection after abdominal blunt trauma. A 29-year-old man visited the emergency room for acute left periumbilical pain after abdominal blunt trauma from his child. Computed tomography showed a wedge-shaped splenic infarction with splenic artery thrombus. He was hospitalized for careful observation, and after two days, follow-up computed tomographic angiography showed a progressed celiac artery dissection that involved common hepatic artery and an increased extent of splenic infarction. He underwent conventional angiography, and a self-expandable stent was placed between the celiac axis and the common hepatic artery. After two days, follow-up computed tomographic angiography showed good hepatic arterial blood flow via the stent and no progression of splenic infarction. After ten days, he was discharged without complications.
Adult ; Angiography ; Axis, Cervical Vertebra ; Celiac Artery* ; Child ; Emergency Service, Hospital ; Follow-Up Studies ; Hepatic Artery ; Humans ; Splenic Artery ; Splenic Infarction ; Stents ; Thrombosis

Near-infrared (NIR) fluorescence imaging is a promising method for image-guided surgery, providing robust functional images with relatively good cost-effectiveness. A cyanine vital dye indocyanine green (ICG) is a safe NIR fluorophore emitting 800~840 nm of light and has been used in numerous surgical procedures. The technique has been applied to lymph node navigation of gastric cancer surgery with an expectation of better visualization of lymphatic structures without any risk of radio-hazard compared with a “dual method” using both vital dyes and radioisotopes. Given the characteristics of ICG, such as fast distribution and quenching effect, diluted concentrations, such as 0.05~0.1 mg/ml, are thought to be optimal for sentinel node navigation. Injection into the subserosal layer is feasible; however, endoscopic submucosal injection has advantages of improved accuracy of the injection site and feasibility of injection one day prior to surgery; these advantages are preferred by some investigators due to a smaller number of sentinel nodes compared with injection in the operation theatre. The technology requires evaluation of the sensitivity and specificity, as well as the non-inferiority, compared with the dual method in a large cohort for justification as a safe node navigation method.
Cohort Studies ; Coloring Agents ; Fluorescence* ; Humans ; Indocyanine Green* ; Lymph Nodes* ; Methods ; Optical Imaging ; Radioisotopes ; Research Personnel ; Sensitivity and Specificity ; Sentinel Lymph Node Biopsy ; Stomach Neoplasms* ; Surgery, Computer-Assisted

PURPOSE: The European Organization for Research and Treatment of Cancer quality-of-life questionnaire-OG25 was developed to evaluate the quality of life in patients with stomach and esophageal cancer. The following are included in the OG25 but not in the STO22: odynophagia, choked when swallowing, weight loss, trouble eating with others, trouble swallowing saliva, trouble talking, and trouble with coughing. In this study, we evaluated the quality of life of gastrectomized patients using both, the OG25 and the STO22. MATERIALS AND METHODS: A total of 138 patients with partial gastrectomy (PG) (distal gastrectomy=91; pylorus-preserving gastrectomy= 47) and 44 patients with total gastrectomy (TG) were prospectively evaluated. Body weight and scores from the OG25 and STO22 were evaluated preoperatively and at 3 weeks, 3 months, and 6 months after surgery. RESULTS: Patients with TG had significant weight loss compared to patients with PG. At 3 months, TG was associated with worse scores for dysphagia, eating, odynophagia, trouble eating with others, trouble with taste, and weight loss on the OG25. TG was also associated with dysphagia, eating restrictions, and anxiety on the STO22. The OG25 helped differentiate between the groups with respect to weight loss, odynophagia, choked when swallowing, and trouble eating with others. The OG25 scores changed over time and were significantly different. CONCLUSIONS: The OG25 is a more sensitive and useful scale than the STO22 for evaluating the quality of life of gastrectomized patients, especially those with total gastrectomy.
Anxiety ; Body Weight ; Cough ; Deglutition ; Deglutition Disorders ; Eating ; Esophageal Neoplasms ; Gastrectomy* ; Humans ; Prospective Studies ; Quality of Life* ; Saliva ; Stomach ; Stomach Neoplasms ; Weight Loss

PURPOSE: The utility of 18-fluordesoxyglucose positron emission tomography ([¹⁸F]-FDG-PET) combined with computer tomography or magnetic resonance imaging (MRI) in gastric cancer remains controversial and a rationale for patient selection is desired. This study aims to establish a preclinical patient-derived xenograft (PDX) based [¹⁸F]-FDG-PET/MRI protocol for gastric cancer and compare different PDX models regarding tumor growth and FDG uptake. MATERIALS AND METHODS: Female BALB/c nuu mice were implanted orthotopically and subcutaneously with gastric cancer PDX. [¹⁸F]-FDG-PET/MRI scanning protocol evaluation included different tumor sizes, FDG doses, scanning intervals, and organ-specific uptake. FDG avidity of similar PDX cases were compared between ortho- and heterotopic tumor implantation methods. Microscopic and immunohistochemical investigations were performed to confirm tumor growth and correlate the glycolysis markers glucose transporter 1 (GLUT1) and hexokinase 2 (HK2) with FDG uptake. RESULTS: Organ-specific uptake analysis showed specific FDG avidity of the tumor tissue. Standard scanning protocol was determined to include 150 μCi FDG injection dose and scanning after one hour. Comparison of heterotopic and orthotopic implanted mice revealed a long growth interval for orthotopic models with a high uptake in similar PDX tissues. The H-score of GLUT1 and HK2 expression in tumor cells correlated with the measured maximal standardized uptake value values (GLUT1: Pearson r=0.743, P=0.009; HK2: Pearson r=0.605, P=0.049). CONCLUSIONS This preclinical gastric cancer PDX based [¹⁸F]-FDG-PET/MRI protocol reveals tumor specific FDG uptake and shows correlation to glucose metabolic proteins. Our findings provide a PET/MRI PDX model that can be applicable for translational gastric cancer research.

PURPOSE: The aim of this study was to establish an anthropometric reference of the stomach for gastric cancer surgery and a modeling formula to predict stomach length. MATERIALS AND METHODS: Data were retrieved for 851 patients who underwent total gastrectomy at the Seoul National University Hospital between 2008 and 2013. Clinicopathological data and measurements from a formalin-fixed specimen were reviewed. The lengths (cm) of the greater curvature (GC) and lesser curvature (LC) were measured. Anthropometric data of the stomach were compared according to age, body weight, height (cm), and body mass index. To predict stomach length, two multiple regression analyses were performed. RESULTS: The mean lengths of the GC and LC were 22.2±3.1 cm and 16.3±2.6 cm, respectively. The men’s GC length was significantly greater than the women’s (22.4±3.1 cm vs. 21.2±2.9 cm, P=0.003). Patients aged >70 years showed significantly longer LC than those aged <50 years (16.9±2.9 cm vs. 15.9±2.4 cm, P=0.002). Patients with body weights >70 kg showed significantly longer GC than those with body weights <55 kg (23.0±2.9 cm vs. 21.4±3.2cm, P<0.001). In the predicted models, 4.11% of the GC was accounted for by age and weight; and 4.94% of the LC, by age, sex, height, and weight. CONCLUSIONS: Sex, age, height, and body weight were associated with the length of the LC, while sex and body weight were the only factors that were associated with the length of the GC. However, the prediction model was not sufficiently strong.
Body Mass Index ; Body Weight ; Gastrectomy ; Humans ; Organ Size ; Seoul ; Stomach Neoplasms ; Stomach*

Many individuals with short bowel syndrome (SBS) require long-term parenteral nutrition (PN) to maintain adequate nutritional status. Herein, we report a successful intestinal adaptation of a patient with SBS through 13 times intensive nutritional support team (NST) managements. A thirty-five-year-old woman who could not eat due to intestinal discontinuity visited Seoul National University Hospital for reconstruction of the bowel. She received laparoscopic Roux-en-Y gastric bypass (RYGB) due to morbid obesity in Jan 2013 at a certain hospital and successfully reduced her weight from 110 kg to 68 kg. However, after a delivery of the second baby by cesarean section in Jul 2016, most of small bowel was herniated through Peterson’s defect, and emergent massive small bowel resection was performed. Thereafter, she visited our hospital for the purpose of intestinal reconstruction. In Sep 2016, she received side–to-side gastrogastrostomy and revision of double barrel enterostomy. The remaining small bowel included whole duodenum, 30 cm of proximal jejunum, and 10 cm of terminal ileum. Pylorus and ileocecal valves were intact. The patient given only PN after surgery was provided rice-based soft fluid diet after 10 day of operation. Through intensive nutritional management care, she could start solid meals, and finally stop the PN and eat only orally at 45 days postoperatively. Three nutritional interventions were conducted over 2 months after the patient was discharged. She did not require PN during this period, and maintained her weight within the normal weight range. Similar interventions could be used for other patients with malabsorption problems similar to SBS.
Bariatric Surgery* ; Cesarean Section ; Diet ; Duodenum ; Enterostomy ; Female ; Gastric Bypass ; Humans ; Ileocecal Valve ; Ileum ; Jejunum ; Meals ; Nutritional Status ; Nutritional Support ; Obesity, Morbid ; Parenteral Nutrition ; Pregnancy ; Pylorus ; Seoul ; Short Bowel Syndrome*

PURPOSE: Intracorporeal anastomosis is the most difficult procedure during pure single-incision distal gastrectomy (SIDG) that affects its generalization. We introduced unaided delta-shaped anastomosis (uDelta), a novel anastomosis technique, for gastroduodenostomy after pure SIDG, and compared the results with those of previously reported Roux-en-Y anastomosis (RY). MATERIALS AND METHODS: Between March 2014 and March 2015, SIDG with D1+ lymph node dissection was performed for early gastric cancer through a 2.5-cm transumbilical incision without any additional port. uDelta was performed by the operator alone, without any intracorporeal assistance. RESULTS: uDelta was performed on 11 patents, and uncut RY was performed on 5-patients without open or multiport conversion. R0 resection was performed in all cases. No significant differences were observed in mean age and body mass index between patients who underwent uDelta or RY. Mean operation times were 214.5+/-36.2 minutes for uDelta and 240.8+/-65.9 minutes for RY, which was not significantly different. Reconstruction time for uDelta was shorter than that for RY, with marginal statistical significance (26.1+/-8.3 minutes vs. 38.0+/-9.1 minutes, P=0.05). There were no intraoperative transfusions, 30-day mortality, or anastomosis-related complications in either group. Average length of hospital stay was 8.2+/-1.9 days in the uDelta group and 7.2+/-0.8 days in the RY group (P=0.320). CONCLUSIONS: After carefully considering indications, uDelta can be a feasible and can be a reproducible reconstruction method after SIDG in early gastric cancer.
Anastomosis, Roux-en-Y* ; Body Mass Index ; Gastrectomy* ; Gastroenterostomy ; Generalization (Psychology) ; Humans ; Laparoscopy ; Length of Stay ; Lymph Node Excision ; Mortality ; Stomach Neoplasms*

PURPOSE: This study aimed to evaluate the value of serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels to detect gastric cancer recurrence. MATERIALS AND METHODS: We retrospectively reviewed 154 patients who developed recurrence within 2 years after curative gastric cancer surgery and analyzed the relationship between postoperative CEA and CA19-9 levels and recurrence. We readjusted the cut-off values to improve the detection of recurrence. Subgroup analysis according to clinicopathologic variables was performed to further investigate the relationship between recurrence and CEA and CA19-9 levels. RESULTS: The sensitivity and specificity for elevated CEA levels to detect recurrence were 40.6% and 89.5%, respectively, and those for CA19-9 were 34.2% and 93.6%, respectively. The sensitivity and specificity for elevation of either tumor marker were 54.3% and 84.0%, respectively; those for elevation of both tumor markers were 19.2% and 98.4%, respectively. By readjusting the cut-off values from 5.0 ng/ml to 5.2 ng/ml for CEA and from 37.00 U/ml to 30.0 U/ml for CA19-9, the sensitivity was increased from 34.2% to 40.2% for CA19-9, while there was no increase in sensitivity for CEA. In subgroup analysis, the sensitivity of CEA was higher in patients with elevated preoperative CEA levels than in patients with normal preoperative CEA levels (86.7% versus 33.7%; P<0.001). Furthermore, the sensitivity of CA19-9 was higher in patients with elevated preoperative CA19-9 levels than in patients with normal preoperative CA19-9 levels (82.61% versus 26.83%; P<0.001). CONCLUSIONS: CEA and/or CA19-9 measurement with the readjusted cut-off values allows for more effective detection of gastric cancer recurrence.
Carcinoembryonic Antigen* ; Humans ; Recurrence* ; Retrospective Studies ; Sensitivity and Specificity ; Stomach Neoplasms* ; Biomarkers, Tumor

PURPOSE: The effectiveness of enteral nutrition for patients with anastomotic leakage after gastric cancer surgery is controversial. The purpose of this study is to compare effectiveness between combined enteral nutrition with parenteral nutrition (EPN) and total parenteral nutrition (TPN). METHODS: Patients who underwent gastric cancer surgery for primary gastric cancer from April 2010 to August 2012 were reviewed. Clinicopathologic characteristics, complication, laboratory tests, and body weight (Bwt) were compared between EPN and PN. RESULTS: Among patients with postoperative leakage within postoperative 1 month (n=43), 13 patients were supported by EPN and 23 patients by TPN. Clinicopathologic characteristics, including preoperative Bwt, body mass index, nutritional status, other complications, and TNM stage were similar. Preoperative serum albumin and Bwt were similar between EPN and TPN. However, after 1 week of nutritional support, albumin at EPN was significantly higher than that of PN (3.52+/-0.3 and 3.25+/-0.3; P=0.010). Adjusted by preoperative Bwt, preoperative nutritional status, and difference in Bwt between preoperative and pre-nutritional support period, decrease of Bwt between pre-nutritional support and discharge was significantly less at EPN than at TPN (-4.5+/-5.4% and -6.3+/-4.1%; P=0.001). CONCLUSION: In terms of the maintenance of serum albumin and Bwt during nutritional support, EPN may be a better supportive option than TPN for patients with anastomotic leakage after gastric cancer surgery.
Anastomotic Leak* ; Body Mass Index ; Body Weight ; Enteral Nutrition ; Gastrectomy ; Humans ; Nutritional Status ; Nutritional Support ; Parenteral Nutrition* ; Parenteral Nutrition, Total ; Serum Albumin ; Stomach Neoplasms*